Acute Focal Bacterial Nephritis Associated With Central Nervous System Manifestations

Abstract

Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney presenting as an inflammatory mass without frank abscess formation. In children, most patients with AFBN present with nonspecific conditions, such as fever, vomiting, and abdominal pain. A small number of reported cases are accompanied by neurological symptoms, including meningeal irritation, unconsciousness, and seizures. We experienced 2 rare cases of AFBN associated with central nervous system lesions. The first case was a 3-year-old girl who had neurological symptoms, including unconsciousness and seizures, with AFBN associated with acute reversible encephalopathy. The second case was a 5-year-old girl who had neurological symptoms, including unconsciousness, with AFBN accompanied by clinically mild encephalitis/encephalopathy with a reversible splenial lesion.

Comparison of mild encephalopathy with reversible splenial lesion with and without acute focal bacterial nephritis

“…The most remarkable difference between the patient groups was that CRP was significantly higher in the MERS with AFBN group. This result corroborated previous case reports of MERS with AFBN (Table 4) [7][8][9].…”

“…Various infectious agents have been associated with MERS, among which viruses are the most common [5]. In recent years, several cases of MERS with acute focal bacterial nephritis (AFBN), a localized bacterial infection of the kidney presenting as inflammatory masses without obvious abscesses [6], have been reported in children [7][8][9]. At least 2-3 weeks of antimicrobial therapy tailored to urinary pathogens is recommended for patients with AFBN [10,11].…”

Acute Focal Bacterial Nephritis Associated With Reversible Splenial Corpus Callosum Lesion

“…We also diagnosed AFBN using abdominal contrast CT. Urinary B2MG and NAG are useful markers for the diagnosis of urinary tract infections [15]. Previous reports have also shown that urinary B2MG and/or NAG are useful markers for the diagnosis of AFBN with and without pyuria [4,7,16]. Therefore, we suspected AFBN based on the high levels of urinary B2MG.…”

“…Okamoto et al [12] reported MERS with a febrile urinary tract infection due to Klebsiella pneumoniae, and Kometani et al [6] reported two cases of MERS associated with AFBN caused by Enterococcus faecalis. Kasuga et al [7] reported a case of MERS with AFBN caused by E. coli. In this study, E. coli was identified in two of the three cases.…”

“…Therefore, they are diagnosed as fever of unknown origin [3,4]. Rare cases of AFBN are accompanied by neurological symptoms such as meningeal irritation, unconsciousness, and seizures [5][6][7].…”